This study was performed to determine if PCI impacts outcomes in patients with extensive stage small cell and have responded to radiation therapy

Materials and Methods

Patients with extensive stage SCLC (ED) received 4 to 6 cycles of chemotherapy and if they had any response to chemotherapy, were randomized to either PCI or no PCI.

Patients were stratified by institute and performance status.

PCI was given to doses of 20 to 30 Gy in 5 to 12 daily fractions.

Eligibility criteria included: WHO performance status of 0-2, documented ED-SCLC before start of chemotherapy, any response after 4 to 6 cycles of chemotherapy, maximum of 5 weeks between chemotherapy and randomization, no evidence of brain or leptomeningeal metastases, no use of corticosteroids, no prior radiotherapy to the head and neck and no prior and/or current other malignancy.

Patients with extensive stage small cell lung cancer who respond to chemotherapy should routinely be offered PCI.

Clinical/Scientific Implications

The authors presented a well designed and executed phase III randomized trial. These results have really dropped a bombshell. Previous data demonstrated a clear survival benefit with PCI in LD SCLC by about 5%. Outcomes for therapy in this disease have been fairly dismal, and ED SCLC has an awful prognosis. This trial showed a doubling of overall survival with a therapy that (at least in the field of oncology) is cheap, safe, and easy to deliver. In fact, toxicities may even be reduced beyond the results described in this study by using more protracted radiation schedules. 20 Gy in 5 fractions is a little more aggressive than most American clinicians would employ because of the risk of late effects. This trial should change the standard of care in this disease, and the authors are correct when they conclude that patients with extensive stage small cell lung cancer should routinely receive PCI.